Delayed puberty

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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Chapter 10 DELAYED PUBERTY

In girls, puberty begins with the development of breast buds, which is controlled by estrogens that are produced by the ovaries. This is followed by the appearance of pubic and axillary hair, which is controlled by androgens that are produced by the adrenal cortex and the ovaries. In addition, there is rapid skeletal growth. Menarche is a late occurrence in puberty.

A patient should be evaluated for delayed puberty if she has not had any breast development by age 13 years or if there is more than a 5-year delay between the initial development of breasts and menarche. Delayed puberty should be classified as constitutional delay, hypogonadotropic hypogonadism (low gonadotropin levels resulting from hypothalamic-pituitary failure), or hypergonadotropic hypogonadism (resulting from gonadal failure with high gonadotropin levels).

Medications Linked to Delayed Puberty

Chemotherapeutic agents

Chronic corticosteroids

Causes of Delayed Puberty

Constitutional Delayed Puberty

Hypogonadotropic Hypogonadism

Congenital hypopituitarism

Central nervous system (CNS) tumors and infiltrative diseases

• Astrocytoma

• Craniopharyngioma

• Histiocytosis X

• Prolactinoma

Excessive exercise

Genetic defects

• Kallmann syndrome

• Leptin receptor deficiency

Post–CNS infection disease

Radiation therapy

• CHARGE syndrome (coloboma, heart disease, atresia choanae, retarded growth and retarded development and/or anomalies, genital hypoplasia, and ear anomalies and/or deafness)

• Gaucher disease

• Lawrence-Moon-Bardet-Biedl syndrome

• LEOPARD syndrome (lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retardation of growth, deafness)

• Prader-Willi syndrome

Systemic illness

• Acquired immunodeficiency syndrome (AIDS)

• Anorexia nervosa or bulimia

• Celiac disease

• Chronic kidney disease

• Cushing syndrome

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